Becoming Hyperaware

Dr. Rasu Shrestha – Chief Strategy Officer and Executive Vice President at Atrium Health – answers bold questions of our readers. Instead of a formal interview, an honest talk about technologies in healthcare.

If a patient gives you a correct answer for a problem, would you rely on the patient’s response, or would you go to a more “respectable” someone who may have a compelling answer?

It’s such a privilege to work in the field of healthcare because we are truly here to serve human beings. That goal of serving is an important concept to grasp – “healthcare” is about the “health” of the patient, and the ‘care’ for the individual and their communities. If we understand that, we will naturally value the opportunity not just to listen and empathize, but also partner with our patients and their circle of trust, and co-craft the patient’s personalized journey towards better health and wellbeing. We should, of course, use our professional judgment to bring in additional insights and evidence-based guidelines, but always ensure that the patient is indeed at the center of any decision we make.

How do you get to real digital transformation?

The past two decades have been about moving from analog to digital, where we have replaced paper, film, and folders with their digital substitutes. While substituting analog with digital was an essential first step, real digital transformation will happen when we genuinely capitalize on the digital assets and connect the digital content from across disparate silos of data repositories and generate new insights that truly move the needle in the way that we’re practicing healthcare. Real digital transformation is about using the power of digital (algorithms, intelligent visualization, smart user interfaces) to allow us to be hyperaware, make more informed decisions, and execute the right actions at the right time in the most impactful ways.

Should we build autonomous AI-based systems in healthcare?

The train has already left the station. AI is here to stay. The real focus needs to be in making sure we have the right guardrails to ensure the proper levels of governance and the right ethical considerations in the pursuit of further embracing AI in healthcare. Done right, AI will dramatically increase the ability for clinicians to better understand and interact with the patients and the populations they care for. Additionally, I hope that advancements in AI will also allow clinicians to be more human – giving them back the gift of time, to be able to connect with their patients meaningfully, to think, and to honestly care in an unrushed and empathetic manner.

“Real digital transformation is about using the power of digital to allow us to be hyperaware, make more informed decisions.”

What are your digital health predictions for 2020?

We have so much to do in 2020, as we look ahead into the bold new decade of leveraging tech for good. My ‘starter list’ of what we can look forward to in 2020:

• We will start to break out of the AI hype cycle and focus on what’s real (and there’s a lot!).
• We will push forward with digital health solutions that focus on the whole person (vs. “just” the patient).
• We will see massive advancements at the intersection of big data and big pharma (e.g., faster/cheaper/better drug discovery and development).

What topics in digital health do you consider as neglected in public debate but will play a considerable role in the future?

Digital health definitely needs to focus more on solving the many challenges of the social determinants of health. These are the real economic and social conditions that truly influence individual and group differences in health status and healthcare outcomes. Digital, done right, has the potential to bridge the many gaps and inequalities that exist – and offer opportunities to have a much more meaningful and sustainable impact on healthcare outcomes.

Can AI find a new drug for cancer?

There’s definite promise in using AI to find cancer (earlier, more accurately) and determine the treatment (faster/cheaper/better drug development and more accurate and earlier determination of the personalized therapies for any individual). There are increasing amounts of efforts amongst pharmaceutical, regulatory, and research, and clinical bodies to leverage advancements in AI to accelerate drug development. AI has ushered in a new era of accelerated drug discovery, where we have exponentially increased capabilities to use patient-driven biological markers and data points to derive more predictive hypotheses vs. the more traditional trial and error approaches that we are used to.

Should there be criteria for effective digital interventions?

Yes, we should have better-defined criteria, better governance, and better guidance around digital interventions. There are ongoing efforts that are just slowing taking form around ensuring that automation via artificial intelligence and machine learning are researched, developed, and deployed in a way that vindicates social values of fairness, human autonomy, and justice. I hope to see more work in this area in 2020!

“The opportunity is for us to engage patients and clinicians in the very design of these solutions, embracing the principles of design-thinking, and creating solutions that increase our efficiency and also delight these end-users.”

Are you not afraid of the future where we all will be monitored continuously? Are people ready for such control?

Some argue that we are already in an era of hyper-surveillance. A recent Forbes article cited how in China, there is now “an unconstrained and unlimited surveillance laboratory across Xinjiang, a province with a larger population than 22 of the European Union’s 28 member states.” Apparently, AI feeds on raw training data and safe haven deployments such as that in Xinjiang, where the technology can be honed and improved. These Orwellian scenarios need to be balanced with efforts to push AI for good and with meaningful conversations and actions around privacy, ethics, and data rights.

Will digital health technologies be a source of new problems and challenges for healthcare worldwide?

We have seen in the last two decades that while adopting digital health technologies such as electronic medical records can indeed make us more efficient in our clinical work through reducing the time required to retrieve charts, improving access to comprehensive patient data, and giving us better ways to manage appointments and prescriptions – these same technologies can also be an impediment to care with challenges of interoperability and clinical workflow. Technology can and will always be a double-edged sword. The opportunity is for us to engage patients and clinicians in the very design of these solutions, embracing the principles of design-thinking, and creating solutions that increase our efficiency and also delight these end-users.

Will companies like Google or Apple become leading healthcare providers soon? If they can offer high-quality services, why should people see this trend negatively?

Back in 2017, Apple explored buying a medical-clinical start-up called Crossover Health, as part of a more significant push into healthcare. Some say that Apple also approached other primary care groups, such as One Medical. More recently, in 2019, Crossover Health acquired Sherpaa, a virtual primary care provider with a digital health platform. Health systems, meanwhile, are upping their game in using digital tools to better the care experience and embrace virtual health to bring more convenient and affordable care to the end-users. The reality is that companies like Google and Apple, as well as health systems like Atrium Health, are trying to meet the evolving needs of the consumer quickly – and a combination of in-person and digital services that up the experience factor for the end-users is exactly what needs to happen. The opportunity for health systems is to rapidly embrace these innovative care models, partner meaningfully with the right players, and balance the efficiency of asynchronous remote care while fostering trust in the long-term relationships with the same provider.

Thank you!

Rasu B. Shrestha, MD, MBA, is executive vice president and chief strategy officer for Atrium Health, one of the most comprehensive and highly integrated not-for-profit healthcare systems in the nation. As a member of the executive leadership team, Dr. Shrestha is responsible for Atrium Health’s enterprise strategy, including planning and tactical direction for the organizatio­­­­n’s current strategic roadmap and beyond. In addition, he spearheads a renewed focus on innovation, launching new healthcare inventions, discoveries, and ideas to benefit our patients and the communities Atrium Health serves. He also provides executive leadership for corporate communications and marketing, as well as enterprise analytics, showcasing Atrium Health as a meaningful, national brand that leverages the power of data and insights.

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